Integrated cancer care: best practice in post-pandemic Australia

THE COVID-19 pandemic has dramatically shifted the cancer care model in Australia, necessitated by the need to balance the risk of infection exposure against the optimal use of health system resources to maximise patient outcomes.

Throughout the course of the pandemic, we’ve seen disruptions to cancer screening, modifications to patient treatment schedules, and decline in cancer research and clinical trials, as well as widespread use of telehealth across the national health care system, the rapid uptake of in-home cancer care including intravenous chemotherapy administration, innovative adaptions to hospital infrastructure models, and shared follow-up care and survivorship care between GPs and specialists.

However, the real challenge will be implementing the lessons learnt over the past 2 years to provide patients with best-practice integrated cancer care.

Integrated care is not a new idea in Australia, having been a policy objective in all states and territories since a Council of Australian Governments (COAG) agreement in 1995. However, multidisciplinary, integrated care for cancer patients is now more important than ever in a changed Australian landscape. Throughout the course of the pandemic, we’ve seen the need for improved virtual communication (here and here), modifications to existing roles and responsibilities, greater focus on local considerations, heightened reassurance of quality and safety, and streamlined continuity of care across primary and secondary settings.

Coordination is at the centre of the integrated model, and the integration of primary into secondary care is fundamental to ensuring patient continuity of care. Primary health care providers play a vital role in helping patients access timely, appropriate cancer care. GPs provide comprehensive ongoing care and connect the community with the rest of the health care sector. Upwards of 85% of cancers are diagnosed following symptomatic presentation to a primary care provider.

Integrated cancer care leads to improved clinical outcomes and a better care experience for patients and their families throughout the treatment journey. A multidisciplinary model of cancer care, using a subspecialist, team-based approach, has been shown to improve mortality rates across many tumour streams, with the lowest rates reflected in local health districts where coordinated, integrated care is practised. Further, a 2021 study of patients with stage II-III rectal cancer demonstrated better survival rates among those in an integrated versus non-integrated cancer care setting.

 Integrated care is not only less fragmented, less costly, and more efficient but also safer and more effective as it minimises the possibility that treatment for one condition, recommended by one provider, interferes with the outcomes of another. Results of a recent systematic review and meta-analysis indicate that integrated care showed both significant reduction in costs and improvement in outcomes compared with usual care, especially in studies with a follow-up period over a year.

However, the COVID-19 pandemic continues to have a profound global impact on cancer care, with the redirection of critical resources, closure of essential screening services, and temporary halting of potentially life-saving clinical trials.

A recent study found around half of Australian patients with cancer experienced disruption to their care during the pandemic. Moreover, almost half of the 150 health care workers agreed there were atypical delays in delivering cancer care and half said access to research and clinical trials had dropped. The reorganisation of cancer care increased the psychological and practical burden on patients and carers, with many flagging concerns about quality and safety amid the pandemic.

Reflecting on the increased need of patients needing heightened reassurance of safety, quality and consistent care, the integrated model needs to consider minimising travel by offering localised care with as many services in one place as possible. The future of integrated cancer services is to augment and expand the existing services locally or on campus, without additional costs to the health care sector.

One such model is our own clinic in Sydney. Integrated cancer treatment is provided on one campus, and includes sub-specialised consultation, surgery, medical oncology, radiation oncology, haematology, diagnostics, imaging, theranostics, cardio-oncology and allied health services and referrals, as well as a comprehensive clinical trial offering. Our clinic also plays host to the Cancer Institute NSW, the Agency for Clinical Innovation and the Clinical Excellence Commission which creates enormous potential for synergy with these agencies to provide further development.

There will also be an urgent need for new models of care to address more complex cancer cases due to the impact of ongoing national lockdowns. Global statistics are showing an increase in complex cancer with more patients presenting with metastatic disease due to delayed diagnosis and treatment. (here, here and here). Patients presenting with later-stage disease often require more treatment than early stage disease, and a multidisciplinary, integrated approach to complex cancer cases is critical for optimising patient outcomes.

The key outcomes – where there is a higher degree of integration of care – are larger impacts on the utilisation of health services and on the health of patients, and these impacts are achieved at less cost.

Professor Stephen Clarke OAM is a medical oncologist at GenesisCare North Shore. He specialises in thoracic and gastrointestinal cancers, including neuroendocrine cancers and mesothelioma. He is also a Professor of Medicine at the University of Sydney.

Professor Nick Pavlakis is a medical oncologist and the Medical Oncologist Site Director at GenesisCare North Shore. He specialises in lung cancer, mesothelioma, gastrointestinal, cancers, and neuroendocrine tumours and his practice philosophy is to provide high quality care with empathy and hope.

 Dr Dasantha Jayamanne is a radiation oncologist and the Radiation Oncologist Site Director at GenesisCare North Shore. He holds particular clinical interests in central nervous system, head and neck, and lung malignancies. Dr Jayamanne is also a clinical lecturer at the University of Sydney.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.